Sorry to hear of the situation. One of the difficult challenges when starting CBT is identifying or re-connecting with things you want, enjoy or need. Depression often leaves people disconnected from these aspects of their lives and it can be hard when they are suddenly asked to start setting goals or identifying what they enjoy.

So, in regards XXXXX XXXXX goals i can be helpful to try and think back to the time before you became unwell and think about things that were happening in your life then that you would like to have back in your life now. What sorts of thins did you used o pend your time ding that you enjoyed? Sports, arts, hobbies, etc? How does your current lifestyle differ from the way you wish it was?

Reduced libido is a common Depressive symptom and unfortunately it can also be a side effect of anti-depressant medication. One of the primary tasks for a prescribing clinician is to determine an effective medication regime with minimal (or tolerable) side effects. Have you discussed this side effect with your doctor? Many people are unwilling to tolerate reduced libido and it would be more than reasonable to request a change of dosage or even a change of medication with the aim of finding a regime that doesn't involve this unwanted side effect. Are you being supervised by a Psychiatrist or a GP?

Thats the thing, before I was depressed, I didn't really have many hobbies. I have more now than i did then.

I've settled down with my girlfriend, and I love her to pieces. I do miss it when she's not around. But I find it hard to interact with her sexually. Although I have no problem on my own... If that makes sense....

I'm being supervised by a GP, i'm drinking less from two pints a day/glass of wine. To maybe a pint and 2 small glasses on a fri/sat night. Diet wise, i've cut out caffine a great deal. I'm eating more fishy foods. I'm taking a mixture of Multivitamin, vitamin b complex and fish oils.

However I'm sleeping more, sometimes oversleeping. This is adding more stress at both work and at home. On top of that i've found my hayfever tablets are interacting with my mirtazapene.

But I just dont know what I want... Before I was ill i wanted a house and a girlfriend..

I have both, so i've achieved those goals... where do i go now is the question. But I dont know how to arrive at the answer.

Even at work now, I feel no enjoyment. I don't know what I want to do, and I feel I have no direction.

I'm being supervised by my GP and I have CBT, although this has largely been telephone based.....

It can be OK to use a GP when medication use is relatively straight forward....your situation is not as you are experiencing unwanted side effects and also possible drug interaction. I strongly recommend you request a referral to a Psychiatrist for a review of your medication regime as a specialist is the appropriate professional to be involved at this point.

Just to clarify, when you talk about goals are you referring to larger life goals rather tan more specific daily goals?

I can appreciate it being an uncomfortable conversation. Try to keep in mind that reduced libido is one of the more common unwanted side effects of antidepressant medication and is often a problem that leads people to requesting changes to their medication. I can assure you that your GP will have had this conversation many, many times before as complications with sexual function are part and parcel of prescribing antidepressants.

In relation to goal setting and moving forward you may find it easier to identify and clarify your values rather than setting goals as a method for guiding future behavior/action. What do you value in different domains of your life? What kind of person do you want to be? Are you acting in a manner that is consistent with your own values? Goals can stem quite naturally once you have clarified values as living in a manner that is consistent with our values usually requires you doing something to meet that value. I can think of an example from one of my one of my patients:

S decided that she valued ongoing personal education. She had finished uni many years earlier and had been working in a stable job since. She decided to enroll in a short night course so that she was acting in a manner that was consistent with this value. She didn't really know what she wanted to study but she decided to enroll in a short history course because it was pursuing further education that she valued rather than the achievement of completing a specific course.

I hope you have had some luck discussing unwanted medication side effects with your GP. If you require further assistance or have other questions in the future please don't hesitate to contact me directly.

Good to hear the medication has been adjusted. I'd be happy to discuss the potential anxiety disorder with you if you'd like. It's a shame you only get 6 sessions of CBT as that is short of what we would expect the minimum required for effective treatment. I do have access to an excellent self-help CBT program and I could send that through as back-up?

I will tell you that...the things you have to go through to be an Expert are quite rigorous.

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